A Young Adult Patient with Rheumatoid Disorder Presents for the Evaluation of Limited Mouth Opening

Juvenile Idiopathic Arthritis (JIA), formerly known as Juvenile Rheumatoid Arthritis, includes all forms of chronic arthritis with unknown etiology that occurs before the age of sixteen. Clinical practice guidelines for JIA management have been evolving for the past 10 years. JIA affects approximately 1 per 1000 children in the U.S. causing short and long-term disability. Polyarticular JIA represents 30% to 40% of JIA and affects five or more joints within 6 months of onset, including the smaller joints, such as the temporomandibular joint (TMJ). TMJ involvement in JIA is between 17% and 87% and can cause craniofacial abnormality resulting in significant functional and aesthetic complications. It is important for the oral healthcare provider to recognize common signs and symptoms of JIA and facilitate multidisciplinary patient care for time management and better prognosis.

A Patient with a History of Tonsillar Cancer Presents for Evaluation of Exposed Alveolar Bone in the Mouth

Osteoradionecrosis (ORN) is a rare but serious late complication of head and neck radiation therapy. The mandible, proximity of the primary tumor to the jawbones, radiation dose, poor oral hygiene, and smoking history are risk factors of ORN. ORN manifests as a chronic infection with exposed jawbone, which typically occurs in the first 3 years after radiotherapy; however, the risk for ORN development occurring in the patients who have undergone head and neck radiation therapy may be indefinite. Surgery has an important role in the management of cases of ORN, ranging from sequestrectomy, debridement, and extensive extirpative procedures with reconstructive surgery.

Dental management of a pediatric patient with Kohlschutter-Tonz syndrome: A case report

INTRODUCTION

Kohlschutter-Tonz syndrome (KTS) is a rare, genetic condition, which typically manifests as a triad of symptoms: 1) amelogenesis imperfecta, 2) infantile onset epilepsy, and 3) intellectual disability. The condition poses dental treatment challenges given the manifestation of amelogenesis imperfecta. Additional considerations are needed to medically manage these patients who present with epilepsy and intellectual disability.

CASE REPORT

Our patient presented with multiple restorative needs, was treated under general anesthesia, and maintained good oral outcomes with close follow-up.

DISCUSSION

To the best of our knowledge, this is the first case report which documents comprehensive dental management of a pediatric patient with KTS.

Influence of topical corticosteroids on malignant transformation of oral lichen planus

BACKGROUND

Oral lichen planus (OLP) is considered an oral potentially malignant disorder. While OLP has been associated with the development of oral squamous cell carcinoma (OSCC), little is known about the role of topical corticosteroids therapy (TCT) in the promotion of carcinogenesis. The study aimed to determine if TCT influences the time of malignant transformation of OLP to OSCC. The study also investigates this correlation in the presence or absence of Candida overgrowth, and in the context of conventional OSCC risk factors such as smoking, alcohol use, and male gender.

METHODS

A retrospective analysis of electronic health records at a tertiary care academic medical center was performed. Patients with OLP and OSCC were considered for inclusion. The diagnosis of OLP required both clinical and histological documentation.

RESULTS

Eighty-two patients met inclusion criteria, consisting of 48 women (58.25%) and 34 men (41.5%) and the mean patient age was 65.9 years (SD = 13.25). Forty-five patients (54.9%) received TCT for OLP before they developed OSCC. The time between the OLP and OSCC diagnoses increased by four years in patients who received topical steroid therapy for OLP (p < 0.001) and decreased by three years (p = 0.010) in those with Candida overgrowth. Gender, smoking, and alcohol use did not have a statistically significant influence on the time between OLP and OSCC.

CONCLUSION

The management of OLP using TCT potentially delayed cancer development in our study. Conversely, it appears that Candida may play a role in the field cancerization of OLP patients.

EBV-positive B-cell ulcerative proliferation in the oral cavity associated with EBV-negative follicular lymphoma in a patient with common variable immunodeficiency: A case report and review of the literature

Lymphoproliferative disorders (LPDs) are a group of conditions characterized by excessive production of lymphocytes manifested in various patterns including lymphadenopathy, tumor-like lesions, and lymphomas. LPD may be stimulated by Epstein-Barr virus (EBV) infection that most commonly appears in the setting of immunocompromised status such as long-term use of immunosuppressive medications and in individuals with primary immunodeficiency disorders. EBV mucocutaneous ulcer is a benign LPD reaction that mostly regresses spontaneously but sometimes requires medical or surgical intervention. This article presents a case of oral EBV mucocutaneous ulceration that affected an individual with a history of complex primary immunodeficiency disorders consisted of common variable immunodeficiency disease associated with T-cell dysfunction. This case is unique because the oral lesions led to the diagnosis of concurrent widespread EBV-negative follicular lymphomas, seemingly unrelated to her EBV-positive LPD oral disease. Yet, both occurred in the setting of severe immunosuppression from the primary immunodeficiency disorders.

Primary Syphilis of the Oral Cavity, a Rare Presentation of a Re-Emerging Disease

Syphilis is a sexually transmitted disease caused by microaerophilic spirochete Treponema pallidum. After contact, T. pallidum infiltrates the genital or oral mucosa and spreads systemically throughout the blood and lymphatic systems. Syphilis is classified into stages, with varying signs and symptoms associated with each stage. Primary syphilis has an incubation period of up to 90 days following the sexual transmission of T. pallidum, and is characterized by the development of chancres at the site of inoculation. Rarely, primary syphilis presents in the tongue, which can mimic many other conditions that affect the oral cavity. In this article, we discuss a rare oral manifestation of primary syphilis. 

Considerations in the evaluation and management of oral potentially malignant disorders during the COVID-19 pandemic

Aim

The COVID‐19 pandemic has resulted in society experiencing unprecedented challenges for health care practitioners and facilities serving at the frontlines of this pandemic. With regard to oral cancer, there is a complete absence of literature regarding the long‐term impact of pandemics on patients with oral potentially malignant disorders (OPMDs). The objective of this article is to put forth an institutional multidisciplinary approach for the evaluation and management of OPMDs.

Methods

A multidisciplinary approach was put formalized within our institution to risk stratify patients based on need for in‐person assessment vs telehealth assessment during the COVID‐19 pandemic.

Results

With judicious risk stratification of patients based on clinical features of their OPMD and with consideration of ongoing mitigation efforts and regional pandemic impact, providers are able to safely care for their patients.

Conclusions

The COVID‐19 pandemic has required health care practitioners to make novel decisions that are new to us with development of creative pathways of care that focused on patient safety, mitigation efforts, and clinical management of disease processes. The care of patients with OPMDs requires special considerations especially as patients at high risk for severe COVID‐19 illness are also higher risk for the development of OPMDs.